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Old 12-08-2011
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Question Adrenal Crisis; Best initial test!

A 63-year-old woman presents to the emergency department with confusion and mental status changes for the last two days. Her family says she has had symptoms of nausea, vomiting, abdominal pain, and diarrhea over the past few days. The patient has a history of cervical cancer, leading to clots in the legs and lungs several months prior to this admission. After a Greenfield filter was placed, she was sent home on coumadin. On this admission, she is found to be febrile with a temperature of 101.5 F orally, a pulse of 115/min, and a blood pressure of 90/60 mm Hg. Laboratory studies show: White cell count 11,000/mm3; hematocrit 31%; platelets 177,000/mm3; sodium 126 mEq/L; potassium 5.7 mEq/L; chloride 114 mEq/L, bicarbonate 22 mEq/L; BUN 33 mg/dL; creatinine 1.2 mg/dL; glucose 57 mg/dL. Prothrombin time 24 seconds; INR 2.2, aPTT 68 seconds. What would be the best initial test?

(A) Plasma renin level
(B) Cosyntropin stimulation test
(C) Serum cortisol level
(D) Lumbar puncture

I have confusion between b & c.
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Old 12-08-2011
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in adrenal crisis first thing to do is get a cortisol level then administer iv fluids and hydrocortisone.
Adrenal Crisis ( fever, altered mental status, low sodium, high potassium, mild acidosis)
so it's choice c. serum cortisol level.
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Old 12-08-2011
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I agree with samstar. Looks like adrenal crisis and serum cortisol levels should be measured first. Co syntropin test is used to locate the cause or source of hypercortisolism.
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Old 12-08-2011
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yep but cosynotropin test is actually to diagnose Addison disease not hypercortisolism ryt ? Dexamethasone suppression test is one for hypercortilosim..
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Old 12-08-2011
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Quote:
Originally Posted by sam88 View Post
yep but cosynotropin test is actually to diagnose Addison disease not hypercortisolism ryt ? Dexamethasone suppression test is one for hypercortilosim..
Addison disease is chronic Adrenal insufficiency while Adrenal Crisis is Acute Adrenal insufficiency. Cosyntropin test can diagnose both but Serum Cortisol is Best Initial Test.

http://emedicine.medscape.com/article/116716-workup
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Old 12-08-2011
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its serum cortisol levels n synacthen test is used for addisonian crisis.
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Old 12-08-2011
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Quote:
Originally Posted by yousuf View Post
its serum cortisol levels n synacthen test is used for addisonian crisis.
both are synthetic ACTH.

Aim is to give ACTH stimulation and measure cortisol level.
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